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General NPI Number Information
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NPI Number | 1811419492
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Entity Type | Organization
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Legal Business Name | BOGLE STREET PHARMACY
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Dates
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Enumeration Date | 07/14/2017
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Last Update Date | 01/29/2020
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Provider Practice Location Address
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Address Line | 311 BOGLE ST
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City | SOMERSET
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State | KY
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Zip | 42503-2873
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Country | US
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Telephone | 606-451-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 744 WHITE TAIL RUN
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City | SOMERSET
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State | KY
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Zip | 42503-7243
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Country | US
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Telephone | 606-416-6061
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY SCOTT
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Credential |
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Telephone | 606-451-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P07854
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License Number State | KY
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